Appeal filed by Dell & Schaefer proves to MetLife that former Morgan Stanley Employee Should Continue to Receive ERISA Long Term Disability Benefits

Author: Attorney Alex Palamara

This former employee of Morgan Stanley came to us after being denied continued Long Term Disability (LTD) benefits by MetLife. Our now client previously worked as a Registered Client Service Associate for Morgan Stanley. This sedentary occupation had her supporting a Financial Advisor or a group of Financial Advisors with a combined annual production of $1,500,000.00 and approximately $200 million dollars under management. Our client worked for Morgan Stanley since 1990. Unfortunately for our client, she was forced to stop working in April of 2012. The combination of her chronic fatigue, severe chronic daily headaches and cognitive impairment prevented her from being able to perform each of the material duties of her own occupation.

Fortunately for our client, her employment at Morgan Stanley provided her with a Long Term Disability Insurance Policy should she be unable to work due to disabling conditions. Afforded such a policy, our client timely filed an application for LTD benefits. After our client filed her claim, MetLife initially approved the claim and paid LTD benefits from October 2, 2012 through September 30, 2014.

MetLife’s Denial

By way of a denial letter dated September 19, 2014, MetLife informed our client that it would no longer pay benefits beyond September 30, 2014. In its denial letter, MetLife stated that it found that our client was only disabled due to a neurotic adjustment disorder and found that such conditions are limited to 24 months of benefits under the policy. MetLife found that her other conditions were not disabling and did not prevent her from performing each of the material duties of her prior occupation. While “Mental or Nervous Disorder or Disease” claims are in fact limited under the terms of the LTD Policy provided by Morgan Stanley, our client’s other conditions fell outside of this limitation and were severe enough to warrant continued benefits.

Claimant Hired Dell & Schaefer

The Employee Retirement Income Security Act of 1974 (ERISA) only provides for 180 days to file an administrative appeal to challenge such a denial. It must be mentioned that if a timely ERISA appeal is not filed, a claimant will likely lose any right they have under the policy for further benefits and they will be unable to file an ERISA lawsuit. Nearly four months after being denied benefits, our client eventually contacted Dell & Schaefer and spoke with disability insurance attorney Alexander Palamara. Although left with limited time to file the administrative appeal, Attorney Palamara quickly took on the case to fight MetLife’s incorrect denial.

Appeal filed by Dell & Schaefer

Armed with limited time, Dell & Schaefer quickly secured any and all updated medical records from our client’s treating physicians as well as the claim file from MetLife. A review of both showed that our client had sufficient proof to justify MetLife overturning its prior decision to deny benefits. A proper and timely appeal was filed prior to the ERISA deadline of 180 days. In the appeal, we were able to show how the combination of her conditions continue to prevent her from performing each of the material duties of her own occupation as a Registered Client Service Associate. Furthermore, in the appeal we pointed out that MetLife’s reviews were very narrow and focused primarily on her psychological conditions. We argued that MetLife’s reviews were biased because MetLife wanted to reach the conclusion that her claim was subject to the limited benefit provisions of the policy. Finally, we noted that it was the consistent opinions of all of our client’s medical providers, and even one of MetLife’s own independent physician consultants, that our client’s disabling conditions and her inability to perform her own occupational duties stems from her physical conditions. With this appeal, we believe that we left MetLife with no reasonable alternative but to reinstate our client’s claim or face a strong lawsuit against its position.

Two weeks and two days after the administrative appeal was sent to MetLife, we received word that our client’s claim had been reinstated and benefits would be payable from October 1, 2014 forward. Although our client is upset due to being denied continued benefits in the first place, she is ecstatic that she found Dell & Schaefer who fought to get her claim reinstated. Likewise, she is now comforted knowing that Dell & Schaefer will do whatever it takes to keep her claim approved until she is able to go back to work or until her policy expires.

If you have any questions with regards to a Long Term Disability Claim, or if your claim has been denied, please do not hesitate to contact the Attorneys at Dell & Schafer for a free consultation.

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